| NPI | 1962765321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: GA 77937) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AL MD.35085) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2019-02-08 |